RESUMO
Total intravenous anesthesia (TIVA) with propofol/remifentanil appears in the literatura as a good option for neurosurgical patients who have increased intracranial pressure (ICP),risk of postoperative nausea and vomiting (PONV), need for neuromonitoring, and in those with impaired brain self-regulation. On the other hand, in patients with normal neurological status, normal ICP, a technique with volatile (halogenated) agents plus an opiiid can be used. This review describes two anesthetic techniques available for use in neurosurgery, highlighting the neurophysiological changes, advantages and disadvantages of each technique. MATERIAL AND METHOD: PubMed search engine was used for bibliographic search. DISCUSSION: The search for an ideal anesthetic in neurosurgery is still a matter of debate. There are numerous investigations aimed at finding an optimal agent that ensure the coupling between cerebral flow (CBF) and metabolism, keeping self-regulation intact without increasing the CBF and intracerebral pressure (ICP). CONCLUSIONS: Both anesthetic techniques, TIVA and volatile agents (halogenated), can be used in neurosurgical procedures and should provide neuroprotection, brain relaxation and a rapid awakening.
La anestesia total endovenosa (TIVA) con propofol/remifentanilo aparece en la literatura como una buena opción para pacientes neuroquirúrgicos que tienen aumento de la presión intracraneana (PIC), riesgo de náuseas y vómitos posoperatorios (NVPO), necesidad de neuromonitoreo, y en aquellos con alteración de la autorregulación cerebral. Por otra parte, en pacientes con estado neurológico normal, PIC normal puede usarse una técnica con agentes volátiles (halogenados) más un opioide. Esta revisión describe dos técnicas anestésicas disponibles para su uso en neurocirugía, destaca los cambios neurofisiológicos, ventajas y desventajas de cada técnica. MATERIAL Y MÉTODO: Para búsqueda bibliográfica se usó buscador PubMed. DISCUSIÓN: La búsqueda de un anestésico ideal en neurocirugía sigue siendo tema de debate. Existen numerosas investigaciones destinadas a buscar un agente óptimo que asegure el acoplamiento entre flujo sanguíneo cerebral (FSC) y metabolismo, manteniendo la autorregulación intacta sin aumentar el FSC y presión intracerebral (PIC). CONCLUSIONES: Ambas técnicas anestésicas, TIVA y agentes volátiles (halogenados), pueden ser usadas en procedimientos neuroquirúrgicos y deben brindar neuroprotección, relajación cerebral y un despertar rápido.
Assuntos
Humanos , Procedimentos Neurocirúrgicos/métodos , Anestesia por Inalação/métodos , Anestesia Intravenosa/métodos , Anestésicos Intravenosos/efeitos adversos , Anestésicos Intravenosos/farmacologia , Anestésicos Inalatórios/efeitos adversos , Anestésicos Inalatórios/farmacologia , Náusea e Vômito Pós-Operatórios/induzido quimicamente , Neuroproteção , Sistema Nervoso/efeitos dos fármacosRESUMO
RESUMEN Introducción: La cirugía ortognática y la rinoplastia son procedimientos consolidados con altas tasas de éxito. La sinergia entre ambos procedimientos ha sido presentada en diferentes investigaciones pero aún no es un procedimiento estándar para pacientes con deformidades faciales. Objetivo: Analizar una serie de casos tratados con cirugía ortognática y rinoplastia y discutir las opciones y fundamentos de la técnica combinada. Material y método: 14 pacientes operados de forma consecutiva fueron incluidos en el estudio. Se identificaron sujetos según el tipo de deformidad facial, el tipo de deformidad nasal y los tipos de cirugías realizadas. El seguimiento mínimo de cada sujeto fue de 12 meses. Resultados: El 50% de los sujetos presentaba deformidad facial de clase III, seguido de deformidades de clase II y I. Las deformidades nasales, de la punta y del puente nasal fueron más prevalentes, siendo el ancho nasal también una deformidad común. En la etapa intraoperatoria, después de realizar la cirugia ortognática, fue necesario realizar un análisis nuevo respecto de la morfologia nasal debido a los cambios que generaba el movimiento maxilar en la condición nasal. Conclusión: La cirugía combinada es sinérgica y viable de ser realizada con bajo número de complicaciones; protocolos y nuevos criterios de análisis son necesarios para obtener mayor predictibilidad en los resultados estéticos.
ABSTRACT Introduction: Orthognathic surgery and rhinoplasty are procedures with high success rate. The synergy between both surgeries has been showed in the past by researches but still they are not standardized procedures for the treatment of patients with facial deformities. Aim: To analyze a case series treated with orthognathic surgery and rinoplasty in the same surgical time, discussing surgical options and techniques in the combined procedure. Material and method: 14 patients were treated consecutively and were included in this research. Subjects were selected by facial deformity, nasal deformity and type of surgery. Minimal follow up was for 12 months to observe results. Results: 50% of subjects showed class III facial deformity, follow by class II and class I facial deformity. In nasal deformities, tip and nasal bridge were more prevalent, being the nasal width a common deformity; in the intraoperative time, after orthognathic surgery, it was necessary to make a new analysis and approach to nasal morphology because the new conditions related to movement of the maxilla. Conclusion: Orthognathic and nasal surgery are good complement and it is possible to do with few complications; surgical protocol and criteria for the analysis are necessaries to obtain more predictability in the esthetic results.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Rinoplastia/métodos , Cirurgia Ortognática/métodos , Anormalidades Congênitas/diagnóstico por imagem , Nariz/cirurgia , Deformidades Dentofaciais/cirurgia , Deformidades Dentofaciais/diagnóstico por imagemRESUMO
RESUMEN La orbitopatía tiroidea es una enfermedad autoinmune, en la que una reacción inflamatoria genera aumento de la presión orbitaria con protrusión de su contenido. A menudo es autolimitada y sus síntomas más frecuentes son retracción palpebral, exoftalmo y diplopía. Existen casos severos con compromiso de la agudeza visual por compresión del nervio óptico. El diagnóstico es clínico, pero debe complementarse con una tomografía computarizada. Su tratamiento depende de la gravedad y actividad de la enfermedad, siendo los procedimientos quirúrgicos, como la descompresión orbitaria, de elección en exoftalmo y neuropatía óptica compresiva. El pilar de tratamiento en la orbitopatía tiroidea severa es la cirugía descompresiva. Se han descrito múltiples técnicas, pero con limitaciones. La descompresión endoscópica transnasal, es considerada actualmente el procedimiento de elección, ya que permite una buena visualización de la pared medial, con resultados comparables y menores complicaciones, respecto a métodos tradicionales. Describimos un caso de oftalmopatía tiroidea severa, con exoftalmo, diplopía y disminución de la agudeza visual, en la que se realizó una descompresión endoscópica con muy buenos resultados.
ABSTRACT Thyroid orbitopathy is an autoimmune disease in which an inflammatory reaction generates increased orbital pressure with protrusion of its contents. It is often self-limiting and its most frequent symptoms are eyelid retraction, exophthalmos and diplopia. There are severe cases with compromised visual acuity due to compression of the optic nerve. The diagnosis is clinical, but must be complemented with a computed tomography scan. Its treatment depends on the severity and activity of the disease and the surgicals procedures such as orbital decompression is the best choice in exophthalmos and compressive optic neuropathy. The treatment in severe thyroid orbitopathy is decompressive surgery. Multiple techniques have been described, but with limitations. The transnasal endoscopic decompression is currently considered the gold standard, since it allows a good visualization of the medial wall with comparable results and less complications, compared to traditional methods. We present a case of severe thyroid ophthalmopathy, with exophthalmos, diplopia and decreased visual acuity, in which a transnasal endoscopic decompression was performed with very good outcomes.
Assuntos
Humanos , Feminino , Adulto , Órbita/cirurgia , Doença de Graves/cirurgia , Descompressão Cirúrgica/métodos , Endoscopia , Tomografia Computadorizada por Raios X , Doenças do Nervo ÓpticoAssuntos
Transtorno Conversivo/complicações , Dispneia/etiologia , Sons Respiratórios/etiologia , Adulto , Transtorno Conversivo/diagnóstico , Transtorno Conversivo/psicologia , Diagnóstico Tardio , Dispneia/diagnóstico , Feminino , Humanos , Sons Respiratórios/diagnóstico , Procedimentos Desnecessários , Disfunção da Prega Vocal/diagnóstico , Disfunção da Prega Vocal/etiologia , Adulto JovemRESUMO
Introducción: La cirugía endoscópica transesfenoidal en la exéresis de patología hipofisaria ha sido ratificada dentro de la mejores opciones para conseguir abordajes exitosos. Para cerrar la brecha ósea, se puede utilizar el colgajo nasoseptal, el cual lograría un cierre adecuado y seguro, evitando complicaciones como persistencia de fístulas de líquido cefalorraquídeo. Dentro de los probables efectos secundarios de este colgajo se señala la presencia de anosmia o hiposmia. Objetivo: Nuestro objetivo es mostrar los resultados obtenidos empleando la técnica del colgajo nasoseptal y la evaluación del olfato posoperatorio. Material y método: Incluimos 14 pacientes con diagnóstico de adenoma hipofisiario intervenidos en nuestro servicio entre diciembre 2014 a diciembre 2015. Se evaluaron diversos parámetros entre otros, olfatometría pre y posoperatorias. A todos se les realizó la técnica endoscópica transesfenoidal. Efectuando la disección del colgajo con la técnica tipo Hadad. La exéresis tumoral fue realizada por neurocirujano, se cubrió la osteotomía con este colgajo. Resultados: De los 14 pacientes, 13 llegaron al estado olfativo preoperatorio. 1 paciente se mantuvo hipósmico mantenidamente. En nuestro estudio, no hemos encontrado deterioro significativo en la calidad del sentido del olfato. Así como tampoco observamos otras complicaciones. Conclusiones: Esta experiencia aún inicial, estimamos que podría ya esbozar una tendencia de mantención de la función olfativa en este tipo de cirugía.
Introduction: Transsphenoidal endoscopic surgery resection of pituitary pathology has been ratified within the best options for successful approaches. To close the gap bone, you can use the nasoseptal flap, which achieved an adequate and secure closure, preventing complications such as persistent cerebrospinal fluid leaks. Among possible side effects of this flap anosmia-hyposmia noted. Aim: Our goal is to show the results obtained using the technique of nasoseptal flap and postoperative evaluation of smell. Material and method: We included 14 patients with a diagnosis of pituitary adenoma surgery in our department between December 2014 to December 2015. Various parameters were evaluated pre and post operative, specially olfactory function. All underwent transsphenoidal endoscopic technique. Performing dissection flap with the technical type Hadad. The tumor resection was performed by neurosurgeon, osteotomy covered with this flap. Results: Of the 14 patients, 13 reached the olfactory preoperative state. 1 patient remained with hyposmia. In our study, we found no significant deterioration in the quality of the sense of smell. Not other complications were found. Conclusions: This is an initial experience, and we estimate that could outline a trend of maintaining olfactory function in this surgery approach.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Adenoma/cirurgia , Endoscopia/métodos , Neoplasias Hipofisárias/cirurgia , Seio Esfenoidal/cirurgia , Adenoma/fisiopatologia , Epidemiologia Descritiva , Septo Nasal/irrigação sanguínea , Neoplasias Hipofisárias/fisiopatologia , Olfato/fisiologia , Retalhos Cirúrgicos , Resultado do TratamentoRESUMO
Ozone (O3) soundings have been performed on Easter Island or Rapa Nui (27°S, 23 109°W, 51 m a.s.l.) since 1994 as part of the Global Atmospheric Watch (GAW) Programme of the World Meteorological Organization (WMO). In this work, we analyze 260 soundings compiled over the period 1994-2014, and make the data available for the international community. We characterize O3 profiles over this remote area of the Pacific by means of statistical analyses that consider, on the one hand, a traditional climatology that describes the data in terms of seasonal cycles based on monthly averages and, on the other hand, a process oriented analysis based on self-organizing maps. Our analyses show the influence of both tropical and subtropical/mid-latitude air masses at Rapa Nui. The former occurs in summer and fall when convective conditions prevail, and the latter in late winter and spring when subsiding conditions are recurrent. The occurrence of stratospheric intrusions in late winter and spring in connection with deep troughs and the presence of the subtropical jet stream is also apparent in the data set. The tropospheric ozone column is in good agreement with the corresponding data derived from satellites but with a systematic overestimate of summer and fall values. We show evidence of an upward trend in ozone near the surface, which suggests the impact of local pollution. We look forward to an enhancement of the Rapa Nui observing site, given its location that offers a privileged position to observe climate change over the sparsely sampled and vast South Pacific Ocean.
RESUMO
Pathogenic Vibrio cholerae isolates, the etiologic agents of cholera, generally express one of two O antigens (O1 or O139). Most environmental isolates are nonpathogenic and are referred to as "non-O1, non-O139". However some V. cholerae non-O1, non-O139 strains are clearly pathogenic and have caused outbreaks or sporadic cases of gastroenteritis and extraintestinal infections in humans. We report a case of acute gastroenteritis by a V. cholerae non-O1, non-O139 harboring a genetic region homologous to a segment of the VpaI-7 V. parahaemolyticus pathogenicity island.
Assuntos
Gastroenterite/microbiologia , Ilhas Genômicas/genética , Vibrioses/microbiologia , Vibrio cholerae/genética , Doença Aguda , Anti-Infecciosos/uso terapêutico , Ciprofloxacina/uso terapêutico , Feminino , Gastroenterite/diagnóstico , Gastroenterite/tratamento farmacológico , Humanos , Pessoa de Meia-Idade , Vibrioses/diagnóstico , Vibrioses/tratamento farmacológico , Vibrio cholerae não O1/genéticaRESUMO
Pathogenic Vibrio cholerae isolates, the etiologic agents of cholera, generally express one of two O antigens (O1 or O139). Most environmental isolates are nonpathogenic and are referred to as "non-O1, non-O139". However some V. cholerae non-O1, non-O139 strains are clearly pathogenic and have caused outbreaks or sporadic cases of gastroenteritis and extraintestinal infections in humans. We report a case of acute gastroenteritis by a V. cholerae non-O1, non-O139 harboring a genetic region homologous to a segment of the VpaI-7 V. parahaemolyticus pathogenicity island.
Cepas patogénicas de Vibrio cholerae, el agente causal del cólera, expresan generalmente uno de dos antígenos O (denominados O1 u O139). La mayoría de las cepas ambientales son no patogénicas y corresponden al tipo denominado "no-O1, no-O139". Sin embargo, algunas cepas de este tipo son claramente patogénas y han causado brotes de gastroenteritis e infecciones extra-intestinales en humanos. Se reporta un caso clínico de gastroenteritis aguda causado por una cepa de V. cholerae no-O1, no-O139 que contiene en su genoma una región homóloga a un segmento de la isla de patogenicidad VpaI-7 descrita previamente en V. parahaemolyticus.
Assuntos
Feminino , Humanos , Pessoa de Meia-Idade , Gastroenterite/microbiologia , Ilhas Genômicas/genética , Vibrioses/microbiologia , Vibrio cholerae/genética , Doença Aguda , Anti-Infecciosos/uso terapêutico , Ciprofloxacina/uso terapêutico , Gastroenterite/diagnóstico , Gastroenterite/tratamento farmacológico , Vibrioses/diagnóstico , Vibrioses/tratamento farmacológico , Vibrio cholerae não O1/genéticaRESUMO
Laparoscopic anterior cardiomyotomy in addition to anterior Dor's fundoplication is the procedure of choice for achalasia of the esophagus with approximately 95% success rate. Redo cardiomyotomy is complicated and associated with rerecurrence of dysphagia. Twelve patients with failed redo myotomy were clinically evaluated with radiology, endoscopy, and manometry in whom achalasia type III or IV was confirmed. We propose as treatment for these selected cases an inversed Y cardioplasty + truncal vagotomy, a partial distal gastrectomy and Roux-en-Y gastrojejunostomy in order to facilitate esophageal emptying and avoid the appearance of postoperative gastroesophageal reflux as a side effect of this procedure. One patient was reoperated on in order to enlarge the cardioplasty. Disappearance of dysphagia was confirmed in all patients. Three patients presented reflux symptoms and were treated with 20 mg of Omeprazole 20 twice/day. No food retention, erosive esophagitis, or Barrett's esophagus were observed. The mean resting pressure decreased from 24.9 +/- 8.5 mm Hg to 7.5 +/- 2.5 mm Hg (P = 0.0001). Furthermore, esophageal diameter decreased significantly after a 5-year follow-up. This procedure could be an option for treating patients in which repeated Heller operations have failed.
Assuntos
Acalasia Esofágica/cirurgia , Estenose Esofágica/cirurgia , Junção Esofagogástrica , Derivação Gástrica/métodos , Gastroplastia/métodos , Vagotomia Troncular , Adulto , Idoso , Idoso de 80 Anos ou mais , Cárdia/cirurgia , Estudos de Coortes , Acalasia Esofágica/complicações , Acalasia Esofágica/patologia , Estenose Esofágica/etiologia , Estenose Esofágica/patologia , Feminino , Refluxo Gastroesofágico/etiologia , Refluxo Gastroesofágico/patologia , Refluxo Gastroesofágico/prevenção & controle , Humanos , Masculino , Pessoa de Meia-Idade , Reoperação , Estudos Retrospectivos , Prevenção Secundária , Adulto JovemRESUMO
BACKGROUND: Gastric microbiota is a complex ecosystem, composed by diverse microorganisms, where H pylori and Lactobacillus are relevant species. AIM: To study the probiotic properties of Lactobacillus spp isolated from gastric biopsies of subjects bearing or not H pylori. MATERIALS AND METHODS: Gastric biopsies from 197 individuals that consulted for gastrointestinal disorders were cultivated in media specific for H pylori and Lactobacillus spp. Probiotic properties of lactobacilli isolates and histological diagnosis of H pylori colonized patients were performed. RESULTS: Among 197 individuals evaluated, Hpylori was detected in 43%, Lactobacillus spp in 24%, while 8% presented both bacteria simultaneously. Forty one percent of the Lactobacillus spp strains produced hydrogen peroxide, S'3% presented a highly hydrophobic surface and 32% had an inhibitory effect upon Hpylori ATCC 43504, even greater than Lactobacillus LGG or LAL reference strains. The main pathological diagnosis of patients ivas chronic non-atrophic gastritis (73%) followed by intestinal metaplasia (19%). A similar proportion of both conditions were observed in patients colonized by Lactobacillus spp, while not colonized individuals developed preferentially chronic non-atrophic gastritis (p =0.002). CONCLUSIONS: Lactobacillus spp and H pylori were mutually excluded, suggesting a competitive colonization model between probiotic bacteria and pathogens .